scholarly journals Prophylactic McCall Culdoplasty by a Vaginal Approach during Mini-Laparoscopic Hysterectomy

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Servet Gencdal ◽  
Emine Demirel ◽  
Zeynep Soyman ◽  
Sefa Kelekci
Keyword(s):  
Sexual Function ◽  
Care Center ◽  
Tertiary Care ◽  
Laparoscopic Hysterectomy ◽  
Control Group ◽  
Apical Support ◽  
Mccall Culdoplasty ◽  
Vaginal Length ◽  
Area Of Concern ◽  
Total Vaginal Length

Background. In gynecological surgery, one particular area of concern after hysterectomy is the risk of developing an enterocele or vaginal apical prolapse. The aims of this study were to evaluate the safety and efficacy of prophylactic McCall culdoplasty (MC) performed during mini-total laparoscopic hysterectomy (mini-TLH), as well as to compare the differences in apical support, total vaginal length (TVL), and sexual function at one and two years postoperatively. Methods. Data were retrospectively reviewed for all women who underwent mini-TLH and mini-TLH + MC at a tertiary care center between August 2012 and January 2016 were from the hospital database. There were 18 women who underwent mini-TLH + MC and were considered as the study group, while 20 women who were treated with mini-TLH were considered as the control group. The primary outcome measures were the differences in apical support and TVL and impact on sexual function. Results. After mini-TLH + MC, the apical vaginal support difference was improved by 2.2 cm. The mean difference in C point was 1.03 cm in the mini-TLH group, which was not significant at two years after the operation. The vaginal vault descent at two years after operation was more prominent in the mini-TLH group than the mini-TLH + MC groups. Apical support changes at two years after the operation were more prominent in the mini-TLH group (0.5 ± 0.6 cm) than the mini-TLH + MC group (1.9 ± 1.2 cm). Conclusion. Prophylactic MC by a vaginal approach during mini-TLH is safe, satisfactory, and efficient for apical support without severe morbidity.

scholarly journals Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality

OTO Open ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 2473974X2097502
Author(s):  
Joseph Chang ◽  
Sen Ninan ◽  
Katherine Liu ◽  
Alfred Marc Iloreta ◽  
Diana Kirke ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Local Anesthesia ◽  
Controlled Trial ◽  
Care Center ◽  
Tertiary Care ◽  
Depression Scale ◽  
Control Group ◽  
Procedure Time ◽  
Pain Scores ◽  
Distress Scale

Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1

scholarly journals Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement?

2020 ◽  
Vol 8 (5) ◽  
pp. 671
Author(s):  
Antonios A. Koutalos ◽  
Athanasios Drakos ◽  
Apostolos Fyllos ◽  
Nikos Doxariotis ◽  
Sokratis Varitimidis ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Total Joint Replacement ◽  
Care Center ◽  
Tertiary Care ◽  
Joint Space ◽  
Control Group ◽  
Treatment Groups ◽  
Vancomycin Powder ◽  
Total Knee ◽  
Hip Arthroplasties

The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA.

Demonstration of an expedited breast care (EBC) clinic

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16023-16023 ◽  
Author(s):  
A. Lopez ◽  
C. C. Venker ◽  
A. Howerter ◽  
G. P. Barker ◽  
A. Bhattacharyya ◽  
...  
Keyword(s):  
Light Microscopy ◽  
Breast Biopsy ◽  
Digital Images ◽  
Care Center ◽  
Tertiary Care ◽  
Control Group ◽  
Tertiary Care Center ◽  
Oncology Care ◽  
Breast Care ◽  
To Receive

16023 Background: Women report waiting for a breast biopsy result as a time of psychological distress. Waiting also delays entry into definitive oncology care, and patients in underserved communities may be lost to follow up. In this proof-of-concept demonstration, an Expedited Breast Care (EBC) clinic was developed to give patients the opportunity to receive same-day biopsy results. Methods: Patients requiring core breast biopsy at a community hospital were approached sequentially to participate. Following surgical biopsy, tissue underwent ultra-rapid fixation and processing. After paraffin sections were prepared and stained, the glass histopathology slides were imaged with a virtual slide scanner. Digital images were stored on a server and viewed on the Internet by a telepathologist at a tertiary care center. Light microscopy review was concurrently performed as the gold standard. After telepathology review and light microscopy confirmation, patients presented to the telemedicine suite to receive biopsy results. A teleoncologist at the tertiary care center presented all pathology results to the patient, whether benign or malignant. Time and patient satisfaction data were collected. Results: Nine patients have participated. Within 2 hours from the time the tissue arrived at the laboratory, digital images were available to the telepathologist. The teleoncologist presented results to patients within 3–5 hours after the biopsy procedure. Patients reported satisfaction with the same-day service, and stated they would seek EBC again in the event of a future breast biopsy. Many patients expressed relief at receiving results so promptly and felt they had avoided the stress of waiting longer for results. The elapsed time from mammogram to definitive oncology care was shorter for EBC patients compared to a control group of patients at a clinic not offering EBC, although the results did not reach statistical significance (Mann-Whitney U: Z = −1.804, p = 0.0713). Conclusions: These data indicate EBC can be successfully accomplished. Current studies to assess EBC’s role in facilitating prompt entry into definitive oncology care are underway. By incorporating rapid tissue processing with telepathology and teleoncology, EBC can improve access to breast care in underserved areas. [Table: see text]

scholarly journals Acute Respiratory Distress and Its Risk Factors among Neonates Admitted in a Tertiary Care Center of Western Nepal

2017 ◽  
Vol 15 (1) ◽  
pp. 5-8
Author(s):  
Jyoti Adhikari ◽  
Sajju Aryal ◽  
Veena Gupta
Keyword(s):  
Respiratory Distress ◽  
Rural Areas ◽  
Teenage Pregnancy ◽  
Care Center ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Early Marriage ◽  
Respiratory Pattern ◽  
Control Group ◽  
Female Ratio

Background: Neonatal period is defined as a period from birth to under 4 weeks (<28 days) of age. It is a highly vulnerable time for an infant, who is completing many of the physiologic adjustments required for extra uterine existence. The term Respiratory distress (RD) is used to indicate signs & symptoms of abnormal respiratory pattern. Methods: All neonates admitted in neonatal intensive care unit of Nepalgunj Medical College, Kohalpur with respiratory distress were included. Same number of age and sex matched controls without RD were selected. Results: The NICU based hospital incidence of RD was 9.1% with  male: female ratio 1.4:1 The Most Common etiology was neonatal sepsis (51.6%), followed by hyaline membrane disease (17.8%), TTN (12.7%), meconium aspiration syndrome (6%), birth asphyxia (5.08%), tracheoesophageal fistula (2%) and pneumothorax (2%). Newborns with poor APGAR score requiring resuscitation were more likely to develop RD (p=0.025). Newborns with birth weight <2.5 kg and >4 kg were 2 times likely to develop RD as compared to control group (p<0.012). There was 7 times higher risk of developing MAS when a baby was born through thick MSL as compared to control group (P<0.022). Inadequate ANC visit significantly increased RD in newborns (p<0.001). Babies born to mother with PROM for more than 18 hours were 5.5 times likely to develop RD (p<0.001) whereas those born to mother who had any source of infection were about 6 times at risk of developing respiratory distress than control group (p=0.007). Conclusion: Certain measures that could be taken to reduce the number of RD are: 1. discouraging early marriage and teenage pregnancy. 2. Increasing awareness regarding temporary and permanent contraceptive measures. 3. Promoting education of girls. 4. Increasing coverage of ANC visit in rural areas and 5. formulating integrated plan and policies from the Government level.

scholarly journals Knowledge and practices among parents of asthmatic children: a quasi-experimental study conducted at tertiary care center of Western India

2021 ◽  
Vol 8 (7) ◽  
pp. 3430
Author(s):  
Dhirja . ◽  
Mukesh C. Sharma ◽  
Jagdish P. Goyal ◽  
Remiya M.
Keyword(s):  
Positive Impact ◽  
Care Center ◽  
Tertiary Care ◽  
Chronic Respiratory Disease ◽  
Primary Caregiver ◽  
Control Group ◽  
Western India ◽  
Control Group Design ◽  
Asthmatic Children ◽  
Quasi Experimental

Background: Asthma is one of the most common chronic respiratory disease of childhood and emerging as a global health issue. It is primary cause of school absences and the third leading cause of hospitalization in children younger than the age of 15 years. Parents as the primary caregiver plays an important in management of the disease. The main objective of this study was to assess the knowledge and practices of parents of asthmatic children and improve it with the help of an informational booklet at AIIMS, Jodhpur.Methods: It was a quasi-experimental, pre-test post-test control group design on 60 parents of children suffering from asthma (30 in control group and 30 in experimental group) coming to paediatric OPD. Non probability purposive sampling was used to select the subjects. Self-structured tools like socio-demographic information, knowledge questionnaire and practices extended questionnaire were used to collect the required data. Reliability and validity of tools were analysed. Data analysis was performed in SPSS version 16.Results: The study findings reveal that most of the subjects had unsatisfactory level of knowledge and practices regarding asthma which significantly improvement in knowledge (t=11.449, p<0.05) and practices (t=-8.079, p<0.05) after application of informational booklet. Knowledge level of subjects were found to have significant association with education, occupation and monthly income of family.Conclusions: Prevention is better than cure. Parents are primary caregiver of children and spend most of the time with them. Their sufficient knowledge regarding asthma and right practices can help in reducing sudden asthma attacks and hospital visit in these children. Informational booklet have a positive impact on improving the knowledge and practices among parents.

scholarly journals MATERNAL OBESITY AND OBSTETRIC OUTCOMES IN A TERTIARY CARE CENTER

2021 ◽  
pp. 1-3
Author(s):  
H. Anitha Virgin Kumari ◽  
S. Nivedita
Keyword(s):  
Body Mass ◽  
Maternal Obesity ◽  
Care Center ◽  
Strong Association ◽  
Tertiary Care ◽  
Obese Group ◽  
Obstetric Outcomes ◽  
Control Group ◽  
Childbearing Age ◽  
Risk Pregnancy

BACKGROUND: Pregnancy is unique, yet normal physiological chapter in women’s life. Pre-existing morbidity can complicate pregnancy affecting mother and fetus resulting in high risk pregnancy .One of which is obesity causing antepartum, intrapartum and postpartum complications both in mother and child. AIM OF THE STUDY: The aim of this study is to evaluate the effect of obesity on the maternal and perinatal outcome in pregnancies complicated by obesity. MATERIALS: A prospective study is done in Govt. RSRM lying in hospital during June 2019-june 2020 .Among antenatal mothers attending antenatal outpatient department, mothers were chosen in their first trimester who had Body Mass Index>30kg/m2 as study group and mothers with a Body Mass Indexbetween18.5kg/m2and25kg/m2 as control group. Detailed history taking and investigations done and they were followed up to delivery and postpartum until discharge and outcome studied. RESULTS: In the present study, increasing age, sedentary lifestyle and low socio economic status show a positive relation to obesity. The proportion of primiparous Women was more in obese group(51.9%)when compared to control group(48.1%). Higher incidence of gestational diabetes and pre eclampsia are seen in obese group. Higher rates of cesarean deliveries among this group. Preterm delivery in obese women 10.4% compared to control group. CONCLUSION: Maternal BMI has a strong association with pregnancy complications and outcome. The best time of intervention may be before a woman considers a pregnancy and attempts are to be made to maintain a normal BMI in women of childbearing age.

scholarly journals The Testosterone Effect on Metabolic and Urologic Outcomes in Patients with Nonfunctioning Pituitary Macroadenomas and Hypogonadotropic Hypogonadism

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Guadalupe Vargas-Ortega ◽  
Gabriel Pérez-Villarreal ◽  
Andrés Ramírez de Santiago ◽  
Lourdes Balcázar-Hernández ◽  
Victoria Mendoza-Zubieta ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Sexual Function ◽  
Metabolic Profile ◽  
Care Center ◽  
Hypogonadotropic Hypogonadism ◽  
Tertiary Care ◽  
Specific Antigen ◽  
Urinary Tract Symptoms ◽  
Retrospective Clinical Study ◽  
Testosterone Effect

Objective. To evaluate cardiovascular risk, metabolic profile, low urinary tract symptoms (LUTS), and sexual function in patients with nonfunctional pituitary macroadenoma (NFPMA) and hypogonadotropic hypogonadism with testosterone therapy (TTh). Methods. A retrospective clinical study at a tertiary care center was performed in 101 men with NFPMA, HH, and TTh; metabolic profile, cardiovascular risk, International Prostate Symptoms Score (IPSS), and International Index of Erectile Function 5 (IIEF-5) scores were evaluated before initiation of TTh and at the last checkup with TTh. Results. Age was 49.3 ± 8.8 years; T before TTh was 195 ng/mL (101–259) vs. 574 (423–774) at the last checkup. The time of TTh administration was 34 months (12–72). An increase in triglyceride levels (200 (153–294) vs. 174 (134–233) mg/dL; p=0.03), dyslipidemia (40% vs. 52%; p=0.03), and MetS (25% vs. 34%; p=0.05) was corroborated. A statistical difference in the Globorisk score and cardiovascular (CV) risk stratification was not found. IIEF-5 score was 15.5 ± 6.5 vs. 17.8 ± 5.3 (p=0.11). An improvement in penetration quality (2.0 ± 1.5 vs. 2.6 ± 1.3; p=0.05), erection after penetration (1.8 ± 1.2 vs. 2.5 ± 1.6; p=0.02), completion of intercourse (1.8 ± 1.2 vs. 2.4 ± 1.3; p=0.03), and satisfaction of sexual intercourse (1.8 ± 1.3 vs. 2.5 ± 1.5; p=0.01) was evidenced. IPSS score was 6 (IQR 2–10) vs. 7 (IQR 4–12); p=0.30. A lower rate of intermittency (14% vs. 3%; p=0.02), urgency (39% vs. 16%; p=0.01), and episodes of nocturia (18% vs. 4%; p=0.02) was found. An increase of hematocrit (44.1 ± 4.4 vs. 47.3 ± 4.4%; p=0.001), hemoglobin (14.9 ± 1.4 vs. 15.9 ± 1.4 g/dL; p=0.001), and prostatic specific antigen (0.59 (0.43–1.19) vs. 0.82 (0.45–1.4) ng/mL; p=0.02) was evidenced during TTh. Conclusion. TTh in young men with NFPMA improves LUTS, sexual function, and some metabolic parameters, and it is relatively safe in the prostatic context.

Correlative Analysis of Atherogenic Dyslipidemia among the Patients with Non Alcoholic Fatty Liver Disease Visiting Tertiary Care Center

2020 ◽  
Vol 5 (3) ◽  
pp. 1132-1136
Author(s):  
Prabodh Risal ◽  
Medha Pandey ◽  
Suraj Makaju Shrestha ◽  
Akash Adhikari ◽  
Saroj Manandhar ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Care Center ◽  
Tertiary Care ◽  
Density Lipoprotein ◽  
Cardiac Risk ◽  
Atherogenic Dyslipidemia ◽  
Control Group ◽  
Alcoholic Fatty Liver ◽  
Alcoholic Fatty Liver Disease

Introduction: Non-alcoholic fatty liver disease (NAFLD) is one of the most prominent causes of chronic liver disease. It is known that dyslipidemia in NAFLD patients may have more severe atherogenic potential with high triglyceride and low density lipoprotein (LDL) as well as less high density lipoprotein (HDL) level. Objective: To determine the atherogenic dyslipidemia and associated factors among patients with NAFLD, Visiting Tertiary Care Center Methodology: Prospective cross-sectional study was conducted at Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) from January, 2016 to December, 2016. All the patients (n= 973) diagnosed to have fatty liver during this study period were initially enrolled in this study. Patients were further asked to fill up the questioner. Out of total 973 cases, 169 patients were identified as NAFLD. Fasting blood sample and anthropometric measurements (BMI, WHR) were taken. After adjusting exclusion criteria, refusal to participate and dropout from the study, 101 patients and 92 apparently healthy age sex matched control group was selected for the study. Blood sugar level and lipid profile were analyzed to assess the risk of athrogenicity among the NAFLD. Result: High total cholesterol was found in 64.4 %, High LDL was found in 20.8 %, Low HDL is present in 72.2% and high triglyceride is present in 65.8 % patients with NAFLD. Non-HDL cholesterol was significantly higher in NAFLD compared to control group (116.75 ± 34.38 vs. 137.63 ± 39.76, p=0.00). Similarly, calculated cardiac risk ratio (TC/HDL) was significant higher (4.15 ± 1.18 vs. 5.25 ± 1.78, p=0.00) whereas atherogenic index of plasma (AIP) was higher (0.30 ± 0.13 vs. 0.33 ± 0.19, p=0.37). Conclusion: NAFLD is significantly associated with atherogenic dyslipidemia. Calculated cardiac risk and AIP is higher in patients with NAFLD. Therefore it may be helpful to assess dyslipidemia among the patients with NAFLD to prevent cardiovascular events.

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